Acceptability,Concerns and Experiences of Men Circumcised by Female Health Providers in Lusaka District

Abstract

Background: The Zambian government has endorsed voluntary medical male circumcision (VMMC) as a biomedical strategy for HIV prevention after a decade of debating its effectiveness in the local setting. The current policy recommends that male circumcision (MC) should be clinically based, as opposed to the alternative of traditional male circumcision (TMC). Acceptability concerns are among the challenges threatening the mass rollout of VMMC. In terms of acceptability, the gender of clinicians conducting the operations may particularly influence health facility-based circumcision. Currently, Zambia is advocating circumcising 80% of all HIV negative men. Most studies globally are on acceptability and barriers to access MC services in general and research is yet to profile the experiences of men who are to be attended to and have been attended to by female providers. Aim: This study explored the concerns and experiences of male clients, of female clinicians or providers taking part in the circumcision procedure. Methods: This was a qualitative study. Data was collected through in-depth interviews with 29 circumcised men at three health facilities. Interviews were audio recorded. Data were verbatim transcribed and analyzed thematically using NVIVO version 10. Results: All 29 participants got circumcised by a female provider. Reasons for accepting were mainly due to lack of choice and that most services offered in health facilities may be done by any experienced provider regardless of gender affiliation. Significant concerns are; shame, stigma and erection. To undress in presence of a female for circumcision purpose was accepted reluctantly owing to culture concerns and that some men erect inadvertently which is rather embarrassing. Additionally male circumcision is an elective procedure and one would wait until a male provider was available. However male circumcision offered in hospitals can be done by any trained health personnel. Conclusions: Concerns and experiences were shame and embarrassment associated with undressing in presence of an opposite sex and the negative attitude of the community to male circumcision offered by female providers. Sex of a provider may be communicated to people or possible clients at individual and community level to prepare clients psychologically. Since the Zambian government is recommending circumcising 80% of all HIV negative men, policy and practice must focus on educating the target group on myths, facts and assumptions surrounding male circumcision offered by female providers. There is room for improvement in modes of offering male circumcision services in health facilities.